P-003: EVALUATION OF TREATMENT PATTERN, HEALTHCARE RESOURCE UTILIZATION AND COSTS OF ILLNESS FOR SICKLE CELL DISEASE IN GHANA: A PRIVATE MEDICAL INSURANCE CLAIMS DATABASE STUDY
Authors: DEI-ADOMAKOH Y., SEGBEFIA C., DWOMOH D., MARFO K., EDGAL A., EGBUJO O., ATAGA K.
Journal: HemaSphere (2022)

Purpose: Sickle cell disease (SCD) is a group of inherited red cell disorders associated with substantial clinical and economic burden. Sub-Saharan Africa accounts for nearly 75% of the global burden of SCD. However, inequities in access to healthcare, including novel therapeutic options, absence of standard treatment guidelines, few dedicated SCD treatment centers and the high cost of treatment have made the management of SCD a challenging task in the region. The current study assessed treatment patterns and healthcare resource utilization (HCRU) and costs in patients with SCD using data from a national Private Medical Insurance database. Materials and methods: Claims data from Ghana’s Nationwide Medical Insurance Database were analyzed between January 1, 2015 and March 31, 2021. Patients with at least 12 months of follow-up data for ≥1 SCD diagnosis claim during the index period (July 1, 2015 to March 31, 2020) and continuous enrollment for at least one claim during the 6-months baseline period prior to index date and 12-months follow-up period post-index date, were included in the study. Healthcare resource utilization and associated costs for patients with SCD were assessed for outpatient and inpatient visits, medications, consumables (medical/surgical supplies) procedures (medical/surgical procedures, diagnostic investigations), services (consultation/hospital services) and other activities (administrative services) during the 12-month follow-up period. Results: Claims data for 2,863 identified patients with SCD (mean age: 20.1 ± 16.0 years; 43.9% males, 56.1% females) were considered. The cohort was stratified by age into two groups: pediatric (<16 years) and adult (≥16 years). The most common complications across all age groups included malaria, upper respiratory tract infection, sepsis, acute chest syndrome, and cellulitis. Most patients were prescribed non-steroidal anti-inflammatory drugs (75.6%), anti-infectives (52.2%), haematinics (27.9%), anti-malarials (26.5%), and opioid analgesics (9.7%), while standard-of-care hydroxyurea was prescribed to only 0.3% of patients. The mean time to first hospitalization was 129.9 ± 107.8 days, and the annual rate of hospitalization was 1.7 ± 1.4 during the 12-month follow-up period. Outpatient claims were higher compared to inpatient claims (2.2 ± 2.4 vs. 1.7 ± 1.4). Most claims pertained to medications (1.9 ± 1.8) and services (2.2 ± 2.3). Costs incurred for inpatient claims were higher compared to outpatient claims (United States Dollar [USD] 261.4 ± 460.5 vs. 56.6 ± 60.4) (Figure 1) during the 12-month follow up period. This was mainly attributed to medications (USD 40.0 ± 117.2) and services (USD 43.3 ± 114.0) (Table 1). Conclusion: To our knowledge, this is the first cost-of-illness study conducted to evaluate HCRU for patients with SCD in Ghana. Our findings suggest that SCD has a substantial impact on healthcare costs in Ghana, consistent with the results of other studies evaluating the economic burden of SCD. Based on our results, use of hydroxyurea therapy as standard of care for SCD management was suboptimal for this cohort of patients. There is an opportunity to increase access to hydroxyurea and other emerging therapies to manage SCD and associated complications, and to reduce the economic burden of the disease.Source for conversion of Cedi to USD currency:https://www.unitconverters.net/currency/ghs-to-usd.htm; Accessed on 21Feb2022 1 Cedi=0.1515234164.Procedures examples: diagnostic investigations, surgical procedures. Services examples: specialist consultation, hospital services. Consumables examples: Oxygen cannula, dressings, syringes, needles, catheters, gloves etc C. SEGBEFIA declares a conflict of interest: Consultancy, Expert: Novartis Steering Committee/Advisory Board Global Blood Therapeutics - DSMB K. MARFO declares a conflict of interest: Stock shareholder: Novartis Other: Novartis employee O. EGBUJO declares a conflict of interest: Stock shareholder: Novartis Shareholder Other: Novartis Employee K. ATAGA declares a conflict of interest: Consultancy, Expert: Novartis, Global Blood Therapeutics, Pfizer, Forma Therapeutics, Agios Pharmaceutics, Novo Nordisk Invitation to national or international congresses: N/A Patent or product inventor: N/A Research support/Scientific studies: Novartis, Global Blood Therapeutics, Forma Therapeutics Stock shareholder: N/A Trainings, Teaching: Novo Nordisk, Novartis